In December 2003 I heard for the first time that with a mammacarcinoma the axilla lymphnodes should also be removed. I then read in the internet about the possible side effects, like movement restrictions, lymphedema etc. Also, that for the majority of women with removed axilla lymphnodes, such an intervention would not at all have been necessary. Thus, prior to the operation, I was intensely concerned with this matter, and could then conclude: unnecessarily removed lymphnodes - that does not have to be!

Preparation for the sentinel node biopsy (SLNB) took place the day before in order to be able to find the sentinel lymphnodes during the surgery.

This method is only practicable if the axillary lymphnodes in the palpation findings and with the ultrasound analysis do not yet look attacked.

If the frozen section during the surgery should, however, give the result that the sentinel lymphnodes contain cancer, then all of the axillary lymphnodes must be removed.

January 29th, 2004: The range of the former lump in the left breast, also the one with the microcalcifications in the right breast, were marked with injected radioactive substance, in order to indicate the situation of the sentinel lymphnodes. These could be found the next day by the gamma detector and be removed by a small cut in the axilla.

My questions and considerations before the surgery:

- Together with the cancer, will there really only be removed the most necessary part from the healthy tissue? The breast was anyway not too voluminous and shouldn’t therefore become much smaller. In thoughts I dispelled the cancer.

- Will it be for sure a breast-conserving surgery with aesthetic appearance and nice, not thick, surgical seams? A good-looking breast is enormously important for a woman (also for older ones!).

The introductory talk with the surgeon, on what should be cut out and on how a good result could be obtained, was very encouraging.

The detailed description of the sentinel node biopsy and further details worked reassuringly. I found it very important to know as much as possible about the coming things, so the inevitable was no more a terrible phantom.

The required cuts were already marked on the skin, which gave me the impression that I would go the next day to a cosmetic surgery.

A quiet fear remained that after the surgery there would be too much of the breast missing... also the fear of the full narcosis.

It would have been a great relief if the surgeon could have visited me still the same day, or at least the next one, although there was a weekend coming up. I would have liked to know this and that about the surgery, also I wouldn’t then have felt so lost. On the last evening in the hospital, he finally visited me. (I know: too little time!)

I was missing strict instructions for the correct movement of my arms. I had on both sides a sentinel node biopsy (SLNB) and knew the advantages of this method. But how did I have to store the arms in bed, how much was it allowed to move them? I was disconcerted. - Later I became aware that only little movement would have been recommendable for a good healing process in the armpit.

For me it would have been helpful to receive already soon after the surgery the dates of the intended longer-lasting examinations and discussions. I was in good physical and also mental condition and I would have liked to fill up the time in between usefully because waiting for the uncertain made me somewhat jerky.

The picture of the skeleton scintigraphy showed no metastases in the bones.

Further data: degenerative changes of the vertebral column (spinal column). Rhizarthrosis left. Degenerative changes of sternoclavicular and AC-joints on both sides.

Hip joint prosthesis on both sides.

The ultrasonography of liver and kidneys showed also no metastases.

My questions after leaving the hospital:

The operation went very well. The drainage tube for the wound liquid on the right could be removed three days later, that on the left, however, only on the day leaving the hospital, thus five days after the operation. The breast was still held in form with transparent adhesive foil. It appeared to have been well shaped, operated on exactly as the doctor beforehand had planned with me.

For me it all went very well, neither a hematoma, nor an infection had occurred (hematoma after biopsy, see clarifications). Pains could also be endured without painkiller. Thus I returned home full of energy.

Then questions appeared:

- How do I have to behave myself when I am back home again? And how long do these behavior rules apply?

I had received many very well-meant advices. I did not know quite exactly what actually was now correct. - I felt, however, so well that I started immediately with the housework, especially with the watering of the numerous flower-pots using a bigger watering-can. That was probably wrong, because the seromes arisen after one week (a swelling caused by the localized accumulation of serum within a tissue in the range of a wound) could have been released by too much movement.

- What is the normal healing process? About how long can it last until the "normal condition" is there again?

- Which complications can occur, and what is to be undertaken in such a case? Such references would have helped me very much after leaving the hospital.

- I should wear immediately after taking off the bandage a tight top. I did not have anything like this with me. - Where could I find in a hurry, coming out the hospital, such a close, suitable top? Where may it be bought? (found in a sports wear shop)

Before entering the hospital unfortunately I did not know that a very close top was needed for the stabilization of the operated breast and necessary for the better healing, and that it already should have been brought along.

COMPLICATIONS: SEROMA

The lymph had itself on the eighth day after the surgery suddenly accumulated, probably I had been too active.

Those seromes (on the pictures still covered with plaster, and like small tennis balls sitting in the armpit) were quite unpleasant. I could not set the arms close to the body anymore, the back musculature cramped very painfully.

Consequently, the liquid had to be punctured several times, until it had found another flow path.

CICATRICES

After taking off the bandage, I was disappointed about the appearance of the seams, I thought that the margins of the skin would lie beautifully next to each other. They were stitched together invisibly, but at both sides of the seams there were a few unpleasant skin rolls. I remembered, that after the hip surgery at a time I had rubbed in "Keli-med", those cicatrices became very fine, hardly perceptible.

Perseverance in putting on the cream, however, is necessary!!

I have thus rubbed onto this scar during a few months this specific ointment: No more bulges, only well visible cicatrices as lines. I wonder if these will further diminish.

2½ YEARS LATER:

Left breast with cicatrice after segment

resection with radial incision.

Right breast with cicatrice after

quadrantectomy with curvilinear incision.

The breast feels good without hardenings.

Now it disturbs me less that the breast is small.

It looks aesthetical.

AGAIN 2½ YEARS LATER:

For some months already, I have been thinking quite often of breast implants, because in the meantime the appearance of the breast has changed. The still existing small breast has become thinner, probably for lack of fatty tissue and also conditioned by age… I am in the meanwhile aged 73 and still weigh only 46 kilos (despite big meals).

Unfortunately nearly the whole scar in the top part of the right breast has grown onto the breast muscle. In its time, there had been much tissue with microcalcifications removed, which is now missing between skin and breast muscle. In the meantime also, the breast muscle towards the shoulder has become more strong, so that now a well visible recession has developed, with which I am not so completely happy.

See the experiments (in German) to free this scar from the breast muscle:

Within the left breast also a recession has developed, however it is not so pronounced and there the scar is flexible.

Since the operation at the end of January 2004, the right shoulder hurts me very much more than this was the case before due to a light arthrosis. The movement of the arm is very reduced, and I ask myself now (and soon also a physician) whether a connection with the deformed scar could exist there.

THE IMPLANTS

Monday, July 6th, 2009: At the Cantonal Hospital in Frauenfeld/CH, I got the scar that had grown onto the breast muscle removed from that, and at the same time I let Polytech silicone breast implants Microthane® polyurethane be inserted (MicroPolyurethane-foam Surfaced / MPS).

For a detailed description (still in German) of the implants and, by further clicking, a documentation of this operation with pictures: